AB1395 PATIENTS’ AND RHEUMATOLOGISTS’ PERCEPTIONS REGARDING TAPERING OF RITUXIMAB
Authors: D. Bertrand, A. Deprez, M. Doumen, D. De Cock, S. Pazmino, A. Marchal, M. Thelissen, J. Joly, B. Neerinckx, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2022)

Background Rituximab is an efficacious drug for the treatment of Rheumatoid Arthritis (RA). The commonly used dose consists of two infusions of 1000 mg with a 2-week interval, but evidence is growing that a lower dose could be as effective. Before implementing a tapering strategy, understanding the perceptions of patients and rheumatologists in this regard is important. Objectives The aim was to investigate patients’ and rheumatologists’ perceptions on rituximab tapering. Methods Patients with RA, who were currently or previously treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in depth, face-to-face, semi-structured interviews. Participants were recruited based on purposive sampling to ensure diversity. Interviews were conducted via video or telephone call. Additional participants were interviewed until data saturation was achieved, meaning no new information emerged from the last 3 interviews. Interviews were audiotaped and transcribed verbatim, followed by analysis according to the Qualitative analysis guide of Leuven, which generated themes. Patient experts were involved in this research. Results In total, 16 patients with RA and 13 rheumatologists were interviewed. Four themes were found: In favour/reluctant of tapering, shared decision making, implementation and evidence gap (Figure 1). Patients and rheumatologists were IN FAVOUR of rituximab tapering, for reasons of safety and economic benefit. Patients and rheumatologists mentioned that a lower dose could allow shorter retreatment intervals, which might avoid flares. Furthermore, rheumatologists referred to available evidence of the effectiveness of a lower rituximab dose. Additionally, patients and rheumatologists indicated that the dose could be tailored based on the patient’s clinical manifestations, e.g. usual cycle interval and disease activity measures. However, some patients and rheumatologists felt RELUCTANT towards rituximab tapering. Patients and rheumatologists were concerned about potential loss of effectiveness and quality of life, next to more practical concerns. Rheumatologists mentioned that they had insufficient experience with rituximab in general to feel comfortable with tapering. Moreover, when applying an on-flare retreatment strategy, patients present with an active disease at the time of retreatment and therefore the option of tapering is less appealing. The next theme was SHARED DECISION MAKING . Patients and rheumatologists mentioned that patients have trust in their physician and thus leave the tapering decision in the hands of the rheumatologists. However, rheumatologists added that this should be combined with explanation of the tapering rationale. Another theme was IMPLEMENTATION . When asking participants about 2 possible dose reduction regimens, a cycle consisting of 2 infusions with a lower dose or a cycle of only 1 infusion with a higher dose, advantages were raised for both regimens (e.g. safety reasons and time savings, respectively). On the other hand, the on-flare retreatment regimen itself was already perceived as a kind of tapering, as the interval is prolonged as much as possible between the cycles. EVIDENCE GAP was the last theme, meaning that patients and rheumatologists felt there was a need of more research regarding rituximab tapering. For instance, predictive tools for flares, as well as the possibility of subcutaneous administration of rituximab, were mentioned as unmet needs by rheumatologists. Figure 1. Conceptual framework of the patients’ and rheumatologists’ perceptions regarding tapering of rituximab. (Icons: Iconfinder) Conclusion It seems that rituximab tapering is not yet incorporated in daily practice as much as tapering of other antirheumatic drugs and this could potentially be related to a lack of experience with rituximab. However, with appropriate education and communication, rheumatologists and patients are willing to taper rituximab. Although, many questions remain, indicating an evidence gap and a need of more research. Disclosure of Interests None declared